Gay couples and women over 40 will be entitled to the same free IVF treatment as heterosexual couples on the NHS for the first time under new guidelines published today.Same sex couples will be given the same rights as heterosexual couples under guidance issued by the killer quango National Institute for Curbing Expenditure (NICE).

The NHS will also extend the upper age limit for IVF by three years to 42, following advice that suggests many women in their late 30s and early 40s could conceive after treatment.

Fertility experts questioned whether health authorities could afford to widen eligibility criteria, when only a quarter currently fund three cycles of IVF for infertile couples, as recommended by Nice.

Gedis Grudzinskas, emeritus professor of obstetrics and gynaecology at Barts and the Royal London Hospital, said that while the new guidance reflects “social changes” there were questions over whether NHS trusts could afford it.

“How do we reconcile the changes in society and equality of access to healthcare, with the economic predicament?” he said.

The new guidelines call on health authorities in England and Wales to fund fertility treatment known as intra-uterine insemination (IUI), using donor sperm, for people in same-sex relationships.

The move follows a relaxation in the law, made under Labour in 2008, to put same sex parenting on an equal legal footing.

The recommendation follows implementation of the Human Fertilisation and Embryology Act 2008. It abolished requirement for fertility clinics to take into account a child’s need for a father or a male role model before agreeing to treatment. Gay couples or single women now need only show they can provide “supportive parenting”.

Demand from gay couples paying privately for fertility services has subsequently boomed, say clinics. Official figures show the number of lesbian couples undergoing IVF rose from 178 in 2007 to 417 in 2010.

One cycle of IVF can cost up to £8,000 privately. Because success rates are low – typically 20 per cent for a 38-year-old – couples can spend tens of thousands on treatment.

Meanwhile Josephine Quintavalle, founder of Comment on Reproductive Ethics, described the same-sex move as “absurd”.

She said: “We are not prepared to accept what constitutes fertility from a biological perspective. Fertility treatment is very important but in this case what we are trying to do is rewrite biology.”

Under the Nice guidelines, women aged 40 to 42 deemed to have no chance of conceiving naturally should be offered one full IVF cycle. In this age group one in eight will give birth after one cycle.

From: http://www.telegraph.co.uk/Gay-couples-and-women-over-40-to-get-free-IVF-treatment-on-NHS

The Office of Fair Trading (OFT) has asked the Competition Commission to launch an investigation into the UK’s £5.5 billion private healthcare market.Following a public consultation in January, the OFT said that it suspected competition was being restricted.

It said it “continues to hold the view that the private healthcare market could work better for patients”.

The market is of growing importance due to an ageing population and improved medical outcomes, according to the OFT.

Among the concerns raised by the OFT are:

• a lack of information about the pricing and quality of services that would enable patients to compare healthcare providers
• the small number of healthcare providers and insurers nationally, which limits choice and competition
• practices that make it harder for new competitors to break into the market, such as loyalty payments to consultants.

The Competition Commission has the power to demand that firms change business practices and spin off specific business interests, if it deems these to be harmful to market competition.

The investigation could take up to two years to complete.

Worries about the breast implants made by PIP have emerged since news of a major investigation into the France firm.Initially it was thought that around 40,000 women in the UK had the implants but yesterday the Department of Health said new evidence meant a further 7,000 women in the UK might have them. About 95% of the implants were provided privately for purely cosmetic reasons.

The French implants caused global concern after it was revealed they contained industrial silicone rather than medical-grade fillers and that they may be more prone to rupture and leakage.

Initially reports also linked the implants to a rare form of cancer known as ALCL. This cancer link has been now been firmly discounted by medical experts here and in Europe.

It isn’t currently known whether the rupture rate for PIPs is higher than for other types of implant.

From the implants that have been tested, there appears to be no risk of dangerous toxic effects in the event of a rupture.

The implants involved are called Poly Implant Prosthèse (PIP) and were made by a French company of the same name.

In a Medical Device Alert in March 2010, the Medical and Healthcare products Regulatory Agency (MHRA) said: ” … most breast implants manufactured by the company since 2001 have been filled with a silicone gel with a composition different from that approved”.

That alert was based on advice from French regulators. However, after an investigation by the MHRA, the French authorities reported in March 2012 that PIP implants made before 2001 may also contain unauthorised silicone gel.

PIP gained approval to market its silicone implants in 1997 but it is not clear when it began using a cheap type of silicone gel intended for making mattresses.

The marketing, distribution and use of the PIP implants was suspended in March 2010.

About one breast implant in five needs replacing within 10 years, whatever the make, so it is unlikely that all the 7,000 women who had PIP implants before 2001 still have the same implants.

An expert committee was set up recently to examine the specific risks associated with PIP implants. It concluded that there was not enough evidence to recommend their early removal. That advice has not changed.

However, the committee said the NHS would remove and replace the implants without charge if patients that the NHS had operated on remained concerned. The government expects the private sector to follow suit.

Women who received a PIP implant from the NHS will be contacted to let them know they have one. If you are worried, you should book a consultation with your specialist or GP.

Some private clinics have said they will replace PIP implants free if clinically necessary.

The expert committee has commissioned further work on the health risks and will meet again in May 2012 to review the findings and update its earlier advice as needed.

Also, the Department of Health has set up two reviews to look at how the PIP situation occurred and the issue of regulating the cosmetic surgery industry as a whole.

The first report is due to be submitted to the health secretary by the end of March 2012.

The Government is trying to reassure women fitted with PIP implants to prevent a rush for NHS surgery to remove faulty breast implants.The adverts, to run in a number of national newspapers at the weekend, will emphasise there is “no clear evidence” that the French made implants cause more harm than other brands.

Almost £135,000 is being spent by the Department of Health on the campaign, which will also run in social media sites. Posters will appear in GPs’ surgeries and hospitals as well.

The advert reads: “The latest advice from the NHS and plastic surgery experts is that women with PiP breast implants do not need to have them removed unless they have symptoms such as pain and tenderness.

“There is no link to cancer and there is no clear evidence of an increased risk of harm compared to other brands of breast implants.”

However, it also states, in large-type at the top of the advert: “The NHS will support women with PiP breast implants.”

Clarifying the situation for those who received implants as part of private breast enlargement operations, it states: “”The NHS will remove your implants if your doctor agrees, but the NHS will not replace implants unless it is clinically necessary.”

It advises those worried about whether they have implants made by Poly Implant Prothese (PIP), which contain industrial-grade silicone, to find out if they have them, to speak to their specialist or GP, and “agree what’s best for you”.

Despite the campaign, Fazel Fatah, president of the British Association of Aesthetic Plastic Surgeons (BAAPS), said the organisation’s stance remained that all 40,000 women fitted with them in Britain should have them removed.

He said: “We remain steadfast in our recommendation to the public of precautionary removal of these defective devices. Although there is no immediate health risk, the gel within these implants is simply not meant to be inside the human body.”

A survey of its 230 members found 95 per cent agreed that “it should be the clinics and hospitals that should pay for the replacement surgery, rather than burden the taxpayer with these costs”.

Women given the PIP implants are due to protest in London on Saturday at the reluctance of private firms like Harley Medical Group, The Hospital Group and Transform Cosmetic Surgery to fund removal and replacement surgery.

Explaining the rationale for the campaign, Andrew Lansley, the Health Secretary, said: “The refusal of some clinics to help their patients has left some of those women worried and confused.

“That’s why we are running this ad campaign, to give women clear, definitive advice about what course of action they should take. I hope it helps women decide what is best for them. We have made it very clear to private companies what we expect of them – to provide their patients with the aftercare that they need and deserve.”

“I do not think it is fair to the taxpayer or other NHS patients for the NHS to foot the bill.  We will pursue private clinics with all means at our disposal to avoid this.”

Professor Sir Bruce Keogh, NHS medical director and leader of an expert group on PIP implants convened by Mr Lansley, said: “At present there is insufficient evidence to recommend routine removal of these implants.

“But I know women will be worried. That’s why the expert group supports the NHS offer and believes the private industry should do the same.”

From: http://www.telegraph.co.uk/Breast-implant-scandal-Government-campaign-to-reassure-women

Ministers have agreed to pay for the removal of the French made PIP breat implants for women who had them on the NHS, and have called on private clinics to acknowledge their “moral duty” to offer the same service.Although the Department of Health said it would “pursue private clinics with all means at its disposal to avoid the taxpayer picking up the bill”, it confirmed on Friday night that it would help women if their clinic was no longer in operation or refused to care for them.

Officials say the implants – thought to have been fitted in some 52,000 women who wanted larger breasts for cosmetic reasons or after cancer surgery – only need to be replaced if they have ruptured but will also carry out the procedure if the patients are worried about them.

Most independent providers have agreed to provide free surgery for their patients who received implants made by the now-defunct Poly Implant Prothèse (PIP) – which were filled with non-medical grade silicone intended for use in mattresses – at least one is holding out while another has so far refused to reveal its policy.

Transform Cosmetic Surgery said the Government needed to “accept its responsibility” for the problem as the implants had been approved for use by a watchdog, the Medicines and Healthcare products Regulatory Agency.

Transform carries out 6,000 breast augmentation procedures a year, and estimates it has fitted some 4,000 women with PIP implants in recent years.

The clinic is currently refusing to pay for them to be removed and replaced and is charging women £2,800 per procedure, although it insists most implants are not at risk of malfunctioning. Some patients have already been booked in for the operation.

It said it would review its stance this week, but if it remains unchanged it could mean the Government has to step in and pay for these women’s operations, at a cost of up to £11.2m.

Nigel Robertson, the chief executive of Transform Cosmetic Surgery, said in a statement: “Transform is fully committed to supporting the Department of Health in its efforts to end the uncertainty and anxiety of British women affected by the PIP situation and awaits a response to its request for an urgent meeting to discuss the way forward.

“It is important to recognise that this crisis is the result of failed regulation of breast implants, which were approved for use. The Government needs to accept its responsibility for this situation and work constructively with us to find a workable solution.”

The other major clinic yet to announce its decision is The Hospital Group.

It is telling patients there is “no evidence to suggest routine removal” of PIP implants but will replace those that have already ruptured “free of charge”.

Other leading providers including BMI Healthcare, Nuffield Health and Spire have agreed to offer free removal of the PIP implants.

Michelle Victor, a solicitor at Leigh Day & Co, said the firm had already been contacted by women seeking help to make private clinics pay for the replacement of their PIP implants.

She said that although the clinics themselves were not responsible for making them, the implants were “not fit for purpose” and so cosmetic surgery groups should remove them.

From: http://www.telegraph.co.uk/Leading-cosmetic-surgery-group-refusing-to-fund-new-breast-implants

Ray King, chief executive of medical group Bupa, has called for a “chronic underfunding” of the care homes system to be addressed “urgently”.He warned that the NHS may face a “bed blocking” crisis unless fees paid to care home operators such as Bupa rise.

Mr King said the number of care home places in the UK will fall unless operators get “fairer fees”.

His comments came as he unveiled a sharp rise in Bupa’s overall global profits, but a fall in the UK division.

About 70% of Bupa’s 18,000 care residents, in its more than 300 homes, are paid for by local authorities- and local authorities pay for well over half of England’s 390,000 care home residents.

But Mr King said operators are seeing a real terms fall in fees as authorities’ budgets come under pressure.

Bupa believes there could be a 100,000 care home bed shortfall within 10 years, if investment in the sector is not increased and current funds are not ring fenced.

This could put pressure on the NHS to take in people who would normally go into care homes.

Bupa, which is a provident company with no shareholders, said its global care services division lifted revenues by 1% to £589 million and profits by 2% to £67.7 million in the half year to June.

But the UK care arm saw a “marginal” fall in profits and occupancy, a situation that could worsen.

Mr King said: “We are calling for the chronic underfunding of the social care system to be urgently addressed. At the absolute minimum, there must be a real terms increase in funding for local authority purchased care home places over 2012-15.”

A nationwide lottery offering couples the chance to win IVF fertility treatment was strongly criticised. At its launch, a UK-based charity offered people – couples or singles of both sexes – the chance to win £25,000 for a round of IVF treatment at a “top clinic”, in return for a £20 ticket.

The lottery is being organised by the charity To Hatch, founded by Camille Strachan, 38, to help people who are struggling to conceive. The winner of the lottery, which is licensed by the UK Gambling Commission, will be randomly selected by a computer in September. Further monthly draws are then planned.

Ms Strachan says she hoped the lottery “can ease the burden on the NHS and reduce the stress on some of those who are struggling.”

It is understood that a number of UK clinics have refused to participate, sparking rumours that a clinic in Barbados would be one of the destinations. Ms Strachan has declined to reveal which “top” clinics would offer the treatment.

The Human Fertilisation and Embryology Authority (HFEA) have criticised the move as “wrong and entirely inappropriate”. They described it as running “counter to the ethos that underpins our regulatory system and clinical practice”.

Dr Allan Pacey, a fertility expert at the University of Sheffield and a spokesperson for the British Fertility Society, said: “In my view it’s a slippery slope to be dishing out healthcare like this, particularly when it comes to children. My mother and father used to say they found me under a gooseberry bush – can you imagine telling a child that he or she was won in a raffle?

“Ethics aside, I think it is precisely the current postcode lottery of NHS funding which makes this charity think it can make this venture a success. Couples either find they can’t get access to NHS treatment or they get only a single attempt and therefore need to fund any further treatment privately if that is unsuccessful.”

Despite criticism of the charity, public responses on internet chat forums were mixed. Although the majority expressed misgivings, hundreds of people indicated on Facebook and Twitter that they intended to buy tickets.

Many took the view that the lottery is a good idea, given what is widely perceived as a cut in the provision of IVF treatment on the NHS.

A spokesman for the Gambling Commission, which regulates lotteries, said: “The commission plays no statutory role in judging ethical questions that fall outside of the Gambling Act 2005. A licence is granted if all the criteria are met.”

From: http://www.independent.co.uk/fertility-doctors-attack-unethical-16320-ivf-raffle

Dr Pierre Dukan, the weight loss guru, whose diets are popular with Gisele Bundchen and Carole Middleton, has lost in court against a rival he accused of libel, and has been fined himself.
Dr Dukan, the creator of a diet which has swept the globe, had filed a legal complaint against Jean-Michel Cohen, who criticised the protein-rich diet in a magazine.

A Paris court ruled on Tuesday that there was nothing libelous about Dr Cohen’s comments, and ordered Dukan to pay £2,700 in damages for “abusive procedure.”

Dr Cohen had warned that Dr Dukan’s methods could lead to serious health problems among some patients.

Dr Dukan issued a statement on Tuesday defending the safety of his diet and suggested Dr Cohen was jealous of the “Dukan phenomenon.”

Dukan’s book was France’s best-selling publication last year and is also a US best-seller. The protein-based diet urges against counting calories, instead allowing dieters to eat as much as they like from a limited list of foodstuffs.

Dr Cohen’s diet says readers can eat anything they like providing they stick to one of four calorie-based programmes of up 1,600 calories a day. The overall aim is to foster good eating habits and take regular exercise.

From: http://www.telegraph.co.uk/Weight-loss-guru-Pierre-Dukan-loses-libel-suit

Drugs used to stimulate the ovaries of older women undergoing IVF treatment may be causing genetic defects in the embryo which have until now gone undetected.
Scientists have discovered abnormalities in the chromosomes of eggs from women over 35 years of age who had been treated with synthetic hormones to stimulate their ovaries prior to IVF.

The researchers said they were surprised to find the chromosome defects which appeared to have occurred during the second stage of the specialised process of cell division that leads to the creation of the human egg cell.

Chromosome defects in eggs were previously considered to have resulted in the first stage of cell division, which occurs when a woman was herself a foetus in the womb. Finding them during the second stage, which occurs at ovulation, therefore suggests they may have resulted from the hyperstimulation of the ovaries during IVF treatment.

The defects included abnormal variations from the usual number of 23 pairs of chromosomes. Three copies of chromosome 21 instead of the normal two, for instance, leads to babies with Down’s syndrome. As women get older it becomes increasingly difficult for them to produce enough viable eggs for IVF treatment. It is common practice for older women to have their ovaries stimulated with stronger doses of drugs than is the case for younger women.

The results of the study are to be presented at a fertility conference in Stockholm this week but the scientists behind the research said that they wanted to reassure older women considering IVF treatment. They said further work needs to be done fully to explain the findings and there is no evidence to suggest that IVF babies of older women are at any higher risk of birth defects than babies conceived naturally by women of the same age.

“We found that some IVF eggs have up to seven chromosome abnormalities. This suggests the possibility that ovarian stimulation during the treatment may have caused some of these defects,” said Professor Alan Handyside, director of the London Bridge Fertility, Gynaecology and Genetics Centre, who led the study.

“These defects are unexpected and it may be that this is just an undiscovered aspect of biology. At the moment all we can say is that this is part of the natural process as women get older.”

The study, which will be presented at the European Society of Human Reproduction and Embryology, analysed more than 100 egg cells from 34 couples undergoing IVF treatment. The average maternal age was 40.

Scientists screened the chromosomes of the eggs and structures known as “polar bodies” that result from a type of cell division known as meiosis. Meiosis is a specialised form of division that results in eggs with half the normal complement of chromosomes – crucial to ensuring that the fertilised egg has the full complement of 46 chromosomes when it fuses with a sperm cell.

The first stage of meiosis occurs when the woman’s ovary is developing in the foetus before birth, when the dividing chromosomes are held together by a kind of cellular “glue” ready for the second stage of division at ovulation.

However, when the ovary of an older women is stimulated with synthetic hormones it is possible that this dislodges the glue prematurely. This might result in abnormal numbers of chromosomes to segregate into the resulting egg cell.

“Our evidence demonstrates that, following IVF, there are multiple chromosome errors in meiotic divisions, suggesting more premature separation of single chromosomes resulting in more random segregation,” Professor Hanyside said.

Stuart Lavery, a consultant gynaecologist at Hammersmith Hospital in London, said “This provides evidence that there is a problem, but it does not prove that it’s treatment related,” Mr Lavery said.

The most important conclusion to be reached from this research isn’t so much the “why” but that the screening process for eggs to be used in IVF must be improved.

It is possible to screen the chromosomes of so-called First Polar Body eggs, at least as part of research. This paper stresses the importance of also screening Second Polar Body eggs, those that have been fertilised.

Doing so will, we can now see, allow us to better identify eggs that have developed abnormalities that result in conditions like Down’s Syndrome.

The issue of whether drugs used to stimulate ovulation are having a role is two-fold. Are the drugs damaging the eggs or simply releasing those that would otherwise be discarded naturally because of abnormalities? Or it could be the drugs have no role at all? We don’t know.

One intriguing point is that if the drugs are a factor we would have anticipated having seen more cases of Down’s Syndrome among older mothers. They may be there but we haven’t detected any such increased risk yet – it means we need to research the possibility.

From:  http://www.independent.co.uk/ivf-drugs-may-be-linked-to-genetic-defects-discovered-in-embryos

Health groups in the UK are calling for a ban on cosmetic surgery prize draws.
The Independent Healthcare Advisory Services (IHAS) and the British Association of Aesthetic Plastic Surgeons (Baaps) have criticised procedures like boob jobs, face lifts and botox being offered through competitions.

They claim cosmetic surgery promotions are becoming more popular, especially over the last three months.

As well as prize draws, they say loyalty card schemes, divorcee packages, magazine competitions and online deals are also big concerns.

Some health experts believe advertising surgery in this way is encouraging young people to get treatments they don’t want or need.

Their concerns come days after My Big Fat Plastic Surgery Prize Draw, the first of a series of monthly events across the UK.

Tickets cost £25, with free entry into a lottery to win £4,000 worth of surgery of your choice.

The event was hosted in a nightclub in London and sponsored by a cosmetic surgery group. Runner-up prizes included fillers and semi-permanent make-up.

Jackie Lewis from Baaps specialises in breast surgery and criticised the draws.

“Cosmetic surgery should not be offered as a commodity prize,” she said. “This is not something that can be trivialised.

“If you’re going to subject yourself to a procedure which is irreversible with lifelong consequences, we recommend you think about it carefully first.”

The Government says you are free to choose where you have cosmetic surgery and the Advertising Standards Agency (ASA) insist all adverts must be socially responsible and not misleading.

From: http://www.bbc.co.uk/newsbeat/13908448